Urgent Care by Minda Wilson: Why have we become so afraid of standing up

Why have we become so afraid of standing up to the insurance companies?

Anthem is pulling back from 16 of 19 pricing regions in California. 59 percent of current enrollment, about 153,000 California’s will lose their existing coverage in 2018 and will, hopefully, find another plan that allows them to keep their doctor on the exchange.

Brian Ternam, President of Anthem Blue Cross of California, said the individual market in California has become unstable so he believes they can no longer offer individual plans.

Trump is threatening to cut subsidy payments for low-income individuals.

From the insurance company’s point of view, this means that, if an individual pays their portion of their insurance premium, even if the government doesn’t pay, the insurance company must pay their portion of all covered expenses for that individual. To get the money the federal government owes them, the insurance company must sue the fed government to collect.

But Ternam’s statement is not true. Anthem is offering individual plans, but only in 3 pricing regions. They are doing this so that they do not lose their right to come into the market in 2019; which would happen If they pulled out altogether.

What is most interesting is that Dave Jones, the California Insurance Commissioner didn’t grow a pair and take a stand.

Even though Anthem is leaving 153,000 without individual coverage, Anthem will still be offering employer provided insurance, Medicare Advantage, Medicare Supplements Policies, Medical Policies, and grandfathered plans purchased before March 2010.

Since he has negotiated with insurance companies in the past, it seems that Commissioner Jones was very capable of cutting a deal. “You, Anthem, want your business, Medicare, Medical plans approved; you want to do business in this state; you have to offer policies in all 19 pricing regions under the same terms and conditions as you are offering them in the 3 remaining regions. You are either all in or all out!” It is inconceivable that Anthem would choose closing its doors altogether rather than find a way to offer policies in the individual markets.

Why have we become so afraid of standing up to the insurance companies?

Even without Anthem, there is sufficient interest from other carriers so that no pricing region in California will be without a coverage option. If one door closes, another door will open.